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PHAR 154 > Constipation > Flashcards

Constipation Flashcards

1
Q

What is considered constipation

A

Less then 3 bowel movements/week that are hard, lumpy, or difficult to pass

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2
Q

Causes of constipation

A

Narcotics
Dehydration
Colon cancer
Elderly
Travel

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3
Q

Complications of constipation

A

Hard stools, rectal bleeding, hemorrhoids

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4
Q

Etiology of constipation

A

“Not a normal part of aging”
Normal is different for everyone
Majority of cases are harmless

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5
Q

What conditions do we need to be cautious with for constipation?

A

Medication-induced constipation
Diabetes
Colon cancer
IBS

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6
Q

When to refer for constipation

A

Longer than 3 days w/o bowel movement
OR 1 week with at-home treatment

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7
Q

Red flags in constipation

A

Changes in stool textures
Blood in stool
Hemorrhoids
Weight loss
Decreased appetite
N+V
Frequent pain
Narrower stools
Unresponsive to treatment

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8
Q

Causes of large bowel obstruction

A

Cancer or large stool

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9
Q

Symptoms of large bowel obstruction

A

Belly cramping and pain
Belly swelling and bloating
Unable to pass gas and stool
Vomiting
More then what is seen in constipation and IBS-C

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10
Q

Non drug treatments for constipation

A

Fluid
Fibre
Exercise

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11
Q

How much fluid should someone with constipation have?

A

Men - 2L
Women - 1.6L

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12
Q

How much fibre should someone with constipation have?

A

For 19-30yo
Men - 34g
Women - 28g

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13
Q

What kind of fibre is best?

A

Insoluble

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14
Q

What is a natural laxative?

A

Prunes

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15
Q

What do prunes contain that is useful for constipation?

A

Insoluble and soluble fibre
Also contain sorbitol - most value here

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16
Q

What are the agents of choice for prevention of constipation?

A

Bulk-forming agents

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17
Q

MOA of bulk forming agents

A

Swells in intestinal fluid -> creates gel -> facilitates passage
Takes a few days to work
Needs intake of fluid

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18
Q

What is a one of the bulk-forming agents?

A

Psyllium (Metamucil)

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19
Q

MOA of psyllium (Metamucil)

A

Increases fecal mass within 48-72 hours

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20
Q

How often do you take psyllium?

A

TID

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21
Q

Side effects of psyllium

A

Psyllium induced obstruction if patient cannot drink much fluid
- Pain, cramps, nausea, no fecal output

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22
Q

When is stool softener useful?

A

For prevention
Common on maternity wards and with palliative care

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23
Q

Efficacy of stool softener

A

LESS effective than bulk-forming agents

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24
Q

What is drug in stool softener?

A

Docusate (colace)

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25
Dosing for docusate
1-2 caps/day 4 caps/day for nursing homes Up to 8 in palliative care
26
How long does docusate take to work?
1-2 days
27
When is docusate contraindicated
With mineral oil
28
What is used as a lubricant for constipation?
Mineral oil
29
MOA of mineral oil
Softens fecal matter by coating it
30
Side effect of mineral oil
Anal seepage Lipid pneumonia when laying down -> avoid HS
31
What are the mineral oil products?
Fleet MO enema - works extremely quick Agarol Magnolax Lanosyl - yummy jelly
32
When is saline(osmotic) useful for constipation?
For bowel evac exams (works within hours) For bowel evac for acute constipation (Fleet)(works within minutes General use - overnight relief (Philips)
33
MOA of saline
Put non-absorbable ions into gut drawing water into the gut
34
Efficacy of saline
NOT useful for seniors due to NO systemic effect
35
What is non-saline osmotic?
Glycerin suppositories Lactulose syrup PEG 3350
36
Who are glycerin suppositories the agent of choice for?
Infants and kids
37
MOA of glycerin suppositories
Osmotic effect and local irritant effect Bowel evac within 30 minutes
38
Side effects of Lactulose syrup
Bloating and gas
39
What is the DOC for prevention therapy?
PEG 3350
40
What does label use say for PEG 3350?
Use <7 days unless MD NOT for kids <18yo unless MD
41
What are the stimulants (rescue agents)?
Senna (senokot) Exlax Dulcolax
42
When are stimulants useful?
Use if NO BM for 3 days when also using preventative agents For overnight relief
43
MOA of stimulants
Irritants/stimulates Ca2+ channels To stimulate pulsing in the gut
44
How fast to stimulants work?
Within 6-12 hours
45
Side effects of stimulants
Bisacodyl and senna are minimally absorbed Diarrhea/cramps
46
What are the herbal products?
Senna, psyllium, bran, aloe, rhubarb
47
What is probiotics use in constipation?
Helps with proper digestion and regularity
48
Prevention ambulatory care
Dietary efforts >> medications Exercise / fluid intake / prune juice Bulk forming agents / docusate / PEG 3350 / Lactulose
49
Acute treatment for ambulatory care
Senna Bisacodyl MoM
50
Red flags in ambulatory care
Unexplained new onset / worsening Blood in stools Weight loss Anorexia Fever N+V Family history of colorectal cancer
51
Prevention in long-term care
Lactulose vs PEG 3350 Docusate Bulking agents
52
Acute treatment for long-term care
Fleet or micro lax or suppository
53
What is normal BM for infants
1 BM per each feed to 1 per week Breast fed ~3/day and formula ~2/day
54
Cause of constipation in infants
Starting solid foods Not getting enough fluids
55
Causes of contraption in children
Too busy to poop Dietary Toilet training issues
56
What % of women experience constipation during pregnancy?
50%
57
Is iron a major cause of constipation in pregnancy?
No
58
Treatment for pregnancy
Docusate - VERY COMMON PEG 3350 - well tolerated Psyllium - well tolerated but just a little less
59
What should NOT be used for treatment in pregnancy?
Senna/bisacodyl - uterine contraction concern MoM = category B
60
Why do diabetics have less BMs?
Nerves are damaged
61
Treatment options for palliative care
Stool softeners - good for prevention Osmotic laxatives - first line therapy Stimulant - commonly used Bulk forming - not recommended
62
Treatment for drug-induced constipation
D/c as many worrisome agents as possible Add fibre Add MoM or PEG 3350 Rescue agent

PHAR 154 (9 decks)

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